Antipsychotic Drugs, the Drug Industry, and Children
May 10, 2007 by Kristina Chew, PhD
Filed under Anorexia, Health, Medicine, Parenting, Psychiatry
Being a parent whose child takes psychatric medications—-Risperdal and Zoloft—-my sense of righteous indignation came quickly to the fore on reading an article in today’s New York Times about how “financial relationships between doctors and drug makers correspond to the growing use of atypicals [antipsychotics] in children.” Noting that Risperdal, Seroquel, Zyprexa, Abilify and Geodon are now being prescribed to a half-million children in the US for behavior problems, the New York Times analyzed data from Minnesota, which is the only state requiring “public reports of all drug company marketing payments to doctors”:
From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than sixfold, to $1.6 million. During those same years, prescriptions of antipsychotics for children in Minnesota’s Medicaid program rose more than ninefold.
Those who took the most money from makers of atypicals tended to prescribe the drugs to children the most often, the data suggest. On average, Minnesota psychiatrists who received at least $5,000 from atypical makers from 2000 to 2005 appear to have written three times as many atypical prescriptions for children as psychiatrists who received less or no money.
……….
But studies present strong evidence that financial interests can affect decisions, often without people knowing it.
I am not suggesting in any way that this sort of questionable financial relationship between drug makers and doctors has anything to do with the medications prescribed for Charlie by his pediatric neurologist, a compassionate man whom we have known for a long time and with whom we communicate well. Charlie takes Risperdal to help him deal with aggressiveness and self-injurious behavior; he takes the Zoloft for anxiety (and there is a link between the anxiety and the behaviors, with the former often preceding the latter). When our doctor first prescribed these medications, he looked at us sternly and said words to the effect of, “But you have to use these in conjunction with a solid educational program. The medicine is only part of it.” Indeed: The medication helps a lot (as we know from attempts to lessen the dosage or to take Charlie off of it), but we have also spent the past two years teaching Charlie how to recognize and communicate his own anxiety (such as asking for a break). This has proved successful by Charlie’s continued long string of peaceful easy-feeling days, despite changes and worries around him (my parents visiting and departing; Charlie’s other grandparents being sick and their usual live-in nurse going on vacation and someone new substituting).
This is all to say, I do not think it would have been right only to give Charlie medication without trying to teach him how to learn other ways of coping with his anxiety and the behaviors he has tended to do when anxious. The New York Times article opens with the story of Anya Bailey who, when she developed an eating disorder after her 12th birthday, was prescribed Risperdal, which is
…… not approved to treat eating disorders, but increased appetite is a common side effect and doctors may prescribe drugs as they see fit. Anya gained weight but within two years developed a crippling knot in her back. She now receives regular injections of Botox to unclench her back muscles. She often awakens crying in pain.
Isabella Bailey, Anya’s mother, said she had no idea that children might be especially susceptible to Risperdal’s side effects. Nor did she know that Risperdal and similar medicines were not approved at the time to treat children, or that medical trials often cited to justify the use of such drugs had as few as eight children taking the drug by the end.
Just as surprising, Ms. Bailey said, was learning that the university psychiatrist who supervised Anya’s care received more than $7,000 from 2003 to 2004 from Johnson & Johnson, Risperdal’s maker, in return for lectures about one of the company’s drugs.
When questioned about why Risperdal was prescribed for Anya Bailey, Dr. George M. Realmuto, a psychiatrist at the University of Minnesota, said that
he did not remember Anya’s case, but speaking generally he defended his unapproved use of Risperdal to counter an eating disorder despite the drug’s risks. “When things are dangerous, you use extraordinary measures,” he said.
Yes, true; in Charlie’s case, we chose to start giving him medication because his behaviors were interfering completely with his learning and were increasing in severity and quantity. Again, this was done while putting into place educational and therapeutic programs to teach Charlie to cope; there are certainly programs (such as the Maudsley approach as well as behavioral treatment) to help someone with an eating disorder get better. The New York Times does not indicate what sort of therapeutic program Anya was in, or whether such was used in conjunction with the medication. It also does not seem that her family was sufficiently warned about the side-effects of Risperdal (our neurologist was very careful to discuss the increasing appetite and tardive dyskinesia, which Anya now has, with us).
I suppose it is stories like Psychiatrists, Children and Drug Industry’s Role in the New York Times that make me wary of the notion of a “magic pill.” When things are dangerous, every last side-effect, evey last detail, every other option, needs to be considered.
Jeff Stimpson
Jill Cornfield
quote: “When things are dangerous, you use extraordinary measures,” he said.
First rule of responsible prescribing: No, you don’t! Extraordinary measures is not an option.
Reading this was so disappointing. Where is the AMA??? Every doctor who is not on the take will now be painted with the same ugly brush.
I am sorry David, you are mistaken. For all treatments, ALWAYS any potential therapeutic effect must be balanced against any and all side effects, as well as the effects of the untreated disorder.
Eating disorders have a bad prognosis with mortality (that is death of patients) 10x or more higher than the general population for anorexia, 2x higher for bulimia.
That is mortality following in-patient treatment and follow up. In addition, there is considerable ill health due to malnutrition.
The object in any treatment is to minimize the the sum of adverse effects from the disorder, and from the treatment. If those adverse effects are less than from the disorder alone, then the treatment is successful. If not, then the treatment should be stopped.
I don’t know if atypical antipsychotics are appropriate for anorexia. Perhaps there are better treatments. If antipsychotics were effective, I think the side effects are modest enough that they would be appropriate.
The possibility of side effects like those the young woman in the NYTimes article—tardive dyskinesia—-underscore how important it is for us parents to do our research, ask questions, observe and discern. Especially as my son could not communicate the kinds of responses that Anya Bailey could. I would also like to know more about the other kinds of therapy/treatment she received.
I feel extremely angry after reading this article. Not for anyting written in it per se, but because the pediatric adhd specialist that is seeing my 8 yr old son recently prescribed .250 mg of Risperdal to help with his underlying anxiety and irritability.
I very pointedly asked him about side effects as I knew of Risperdal from my past work with severly mentally ill social assistance clients. THE ONLY side effects he bothered mentioning were dry mouth and weight gain. HE NEVER mentioned the possibility of tardive dyskinesia.
Thank GOD, I have not given him the med yet as it was just not sitting well with me. I had been seeking opinions about it from his psychologist, his G.P and a pharmacist.
My son doesn’t even exhibit violent behavior at all! It seems like a sledge hammer solution for “underlying irritability”.
I am really TICKED off at this doctor whom I am supposed to ‘trust’. This is the SECOND time in the past 2.5 years where I have felt snowed by psychiatrists that are so eager to medicate my boy who is adhd, learning disabled in non-verbal and gifted.
Can anyone be trusted?????
These are all interesting views.
I remember Johnson and Johnson saying Oxycotin is the new drug for Autism.
This sent a red flag to me. Oxycotin is a serious narcotic.
Then yesterday they released a statement involving the makers of Oxycotin are being sued because of false statements on the safety of the drug.
I know people sometimes need meds. And I realize the argument on all sides of giving these meds.
And how much money these pharmaceutical companies profit. I believe like it was mentioned that if these meds are given there should programs to help with behavioral issues. I feel the drugs aren’t the only answer.
A lot was made of oxytocin after research was presented on it at IMFAR, as in this Seattle Times article. A mother commented on the effects of oxytocin on her 21-year-old son who has Asperger’s in this post:
Oxytocin is a neuropeptide and massively involved in the mediation of attachment. It is completely different than OxyContin which is a very strong narcotic.
Thanks a lot for clarifying that—-I just realized how close the names (Oxytocin/OxyContin) are.
On using an antipsychotic drug because it’s an appetite stimulant — there are much safer appetite stimulants out there! There’s one that was originally developed as an antihistimine, but it caused increased appetite in most people, and wasn’t as good an antihistimine as other available ones. An antihistimine is generally a lot safer than an antipsychotic!
(I just wish I could remember the name of it!)
I’m appalled.
There were a few details ommitted by Gardiner Harris in the article concerning my daughter. My daughter also has a refractory epilepsy, and when her seizures aren’t under control she’s had a slew of psychiatric problems in the past. The three child psychiatrists at the U/MN who prescribed Risperdal to my daughter told me there were no risks of “tardive” with this drug. They also told me to give Risperdal to her as a PRN (as needed) whenever she became angry. I was also never told that my daughter was being used in a research study. Dr Realmuto is quoted in previous articles by Gardiner Harris as “not asking for the parents permission” in his research. Dr Realmuto was also heavily involved in a push for the drug Concerta about 8 yrs prior to this at the U/MN and I know that another doctor was found guilty of research fraud in this study.
I just hope Anya’s story can at least open the eyes of other desperate parents (let’s face it, by the time we’re going to a shrink, it’s a difficult journey, even desperate)—to not give all authoritative care over to a doctor. Because that Hippocratic Oath ‘to first do no harm’ obviously gets displaced when financial incentives under the guise of advancing research… seductively and meretriciously lure these under-salaried doctors (or actors as Dr Realmuto posed his response to the NY Times).
Mrs. Bailey, I can’t thank you enough for writing here and sharing more about your daughter and your family. As I wrote, my son’s neurologist made it clear that there were side effects and insisted that we look into these ourselves, regarding any concerns. If it is all right, I would like to email you privately.
Thank you very much and many many regards to your family.
Kristina Chew
Oh, this is such a tough issue!
We are really just so early in the process of understanding the potential - good and ill - of these drugs.
As parents we can’t treat the doctors like gods who know best, or expect perfect knowledge.
And the doctors are simply going to need to come off the dais and TALK with parents frankly about what they know and don’t know.
Thank you, Kristina, for making this conversation happen!